As the case load rose, and states faced staff and resource crunches, contact tracing became a casualty
For most states, it is a dearth of manpower that is the primary reason for low contact tracing
India’s covid-19 case load has crossed 1.4 million, but a vital tool to contain transmission has been all but abandoned by many states. Most states have reduced the contact tracing done as soon as a person tests positive for the virus.
As the case load rose, and states faced staff and resource crunches, contact tracing became a casualty. Karnataka, for instance, which was tracing an average of 47 contacts for every person who tested positive in March, is now just tracing three to five. Contact tracing requires a great deal of rigour and resources. Tamil Nadu traces about 14 contacts for each positive case. An ICMR study said the rate of infection among contacts was high in many states but their contact tracing was low.
For the first three days she was in the hospital after testing positive for covid-19, most of Diya Naidu’s time was spent answering questions from health department officials, who wanted to trace and isolate all the people who had met her in the previous two weeks. “The process was rigorous. They asked me about all the people I had met enroute from Switzerland to Bengaluru," said the dancer-choreographer, who has recovered from the virus and is one of the state’s first plasma donors.
For most states, it is a dearth of manpower that is the primary reason for low contact tracing. “The same manpower is busy handling the surge in cases, the deaths and the tracing," said Dr Pramukh Natesh, health data analyst.
Dr Nutan Mundeja, Director, General Health Services, Delhi, said contact tracing is the backbone of containment but people are hesitant to name everyone they have come in contact with. “There is a lack of willingness to come forward to share contact details despite best efforts. People name just 5-6 contacts over 15 days. We need more details so that we can find out from whom they got the disease, and who might have got it from them. If the contacts are traced and quarantined, containment becomes easier," she said. “Most people are not able to give an accurate account of their high-risk contacts," said Dr. Mundeja.
There is a need to involve the community, and foster a feeling of responsibility. “Making people aware about the importance, reducing stigma, and encouraging home quarantine will go a long way," said Dr Jugal Kishore, head, department of community medicine, Safdarjung Hospital, Delhi.
“Aggressive house-to-house surveillance should have been done since the beginning and continued through April, May and June. Now, focus should just be on identifying high-risk people and areas, quarantining them and tracing their contacts and secondary contacts. The door-to-door survey should be repeated every fortnight," he said.
Across the country, contact tracing has been largely limited to high-risk direct contacts. The National Centre for Disease Control guidelines clearly emphasize that low-risk contacts can be a potential disease source too.
Dr T Jacob John, virologist and former head of clinical virology at CMC Vellore, said that India, like other developed countries, should have by now to case-based diagnosis and contact tracing. He said any strategy will only reduce the speed of virus transmission but cannot stop it completely. “The virus will achieve pan-endemic status in India by year end or next February. It means the disease rate will come down to less than 1%. The disease will neither disappear nor bother the community, like influenza. The idea is to make the epidemic look endemic, that will be flattening the curve," he said.
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